Individual
MR. TIMOTHY PRYOR LUCKETT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
REGISTERED NURSE
Contact information
Practice address
14171 SHEPHERD DR, RANCHO CUCAMONGA, CA 91739-2215
(909) 268-2126
(909) 899-8850
Mailing address
14171 SHEPHERD DR, RANCHO CUCAMONGA, CA 91739-2215
(909) 268-2126
(909) 899-8850
Taxonomy
Speciality
Code
Description
License number
State
163WR0006X
Registered Nurse First Assistant
Primary
RN290090
CA
Other
Enumeration date
10/10/2007
Last updated
10/10/2007
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